PEBB FAQs

All benefits, including medical, pharmacy and dental plans, are administered on a calendar-year basis. The plan year begins January 1st and goes through December 31st.

If you do not enroll when originally eligible, you can only enroll during the annual Open Enrollment period, unless you experience a qualified status change.

You are not required to use your Social Security numbers as identification. PEBB will assign unique identification numbers. These numbers also are used by Moda Health. Always present your Moda Health ID cards when receiving services. Providers should bill Moda Health using the unique ID number located on the member's ID card.

The deductible still must be met prior to any benefit reimbursement, but in some cases the secondary plan will pay part of the deductible amount left over from the primary plan. Examples of how plans coordinate benefits can be found in the medical, pharmacy and dental sections.

Active PEBB employees and their dependents in Oregon, Idaho, Southern Washington and Northern California will use the statewide Synergy Network. Out-of-area dependents (such as college students) who reside outside the state of Oregon will use the following networks as their primary network:

• Alaska: First Health
• Idaho: First Health and Synergy networks
• All other states: Aetna PPO® through the Aetna Signature Administrators®

With our medical plans, you have access to our travel network which allows you to receive urgent and/or emergent care outside of your primary service area while traveling. You need to seek care from an Aetna PPO® through Aetna Signature Administrators® provider to receive in-network benefits. The Moda Health travel network is not an alternative primary network. You must seek in-network services whenever possible, and preauthorization is required for in-patient services. You can locate Aetna PPO® through Aetna Signature Administrators® providers through FindCare, our online provider directory.

Active employees, retirees and your dependents enrolled in PEBB Dental Premier® plans will use the Delta Dental Premier® Network. Active employees, retirees and your dependents enrolled in PEBB's Delta Dental PPOSM plan will use the Delta Dental PPOSM Network. Both the Delta Dental Premier® and Delta Dental PPOSM networks include access to the Delta Dental Provider Network nationwide. If enrolled in the Delta Dental PPOSM plan and you see a Delta Dental Premier® provider who does not participate in the PPO Provider Network you will receive the out-of-network benefit level.

You have access to the Synergy Network. Out-of-area dependents may have a different network depending on where they reside (see question 1. above). You can find providers in your network by using our online Find Care tool and entering your PEBB ID number. If you are not yet active on a Moda Health medical plan, you can search by network by selecting the appropriate network from the "Networks" drop-down box.

The best way to search is by the provider's last name or ZIP code because providers with multiple practice specialties may not be listed under all their specialties. You can search for the provider by name, specialty, ZIP code or city where the provider is located.

You should be sure to select the appropriate network (Synergy.) Moda 360 Health Navigators are also available to help you locate in-network providers and can help verify if a provider is in-network for a plan.

No. The provider will be paid the in-network rate only after being added to the network.

You use a network called the ArrayRx Core network. This network excludes CVS pharmacies. You can find in-network pharmacies by choosing "ArrayRx Core network" from the Networks drop-down box in Find Care. You can also call your Moda 360 Health Navigator team at 844-776-1594.